Romania has a pharmaceutical market of 5.47 billion Lei (1,550 million Euro) in 2006, where the market for prescription drugs was about 4.58 billion Lei, of which 80% are financed by health insurance. Market growth has been more than 20% p.a. over the last years, but per capita drug consumption is still low with an average of 75 Euro per year. Consumption is higher in urban and lower in rural areas, in line with income differences and access to providers (prescribing physicians and pharmacies). Fifty percent of the population lives in rural areas, but only 20% of doctors and 30% of pharmacists practice their profession there. The drug market is growing mainly due to the introduction of new, expensive drugs, although generics are dominant in volume terms. Several of these new drugs have made it under the top 20 in terms of sales, although there are only a small number of patients benefiting from them. Access of drugs to the reimbursement lists (providing 90%, 50% or full reimbursement depending on the classification of a drug) is based on a commission recommendation. The commissions in charge are dominated by the medical profession; commission members are not financially accountable for the impact of their decisions. The health insurance house uses budget caps for pharmacies as a rationing tool, which creates patient dissatisfaction and keeps drug reimbursement issues in the public debate. Pricing and reimbursement decisions are not well coordinated between Ministry of Public Health (MOPH) and Health Insurance House. Stakeholders also complain that procedures are not sufficiently transparent and that unethical practices can influence decision making, promotion and utilization of drugs. Prescribing practices of physicians are not informed by clinical guidelines; abuse is likely. There is no information system that would allow real time and systematic analysis of the prescribing practice of individual physicians...